Soft tissue
Fibroblastic / myofibroblastic tumors
Calcifying aponeurotic fibroma

Author: Komal Arora, M.D. (see Authors page)

Revised: 12 August 2016, last major update July 2012

Copyright: (c) 2002-2016,, Inc.

PubMed Search: Calcifying aponeurotic fibroma

Cite this page: Calcifying aponeurotic fibroma. website. Accessed October 26th, 2016.
Definition / General
  • Rare, slow growing, painless tumor with fibroblasts palisading around chondroid or calcified nodules, usually in hands and feet of children or young adults; rarely at other sites (Hum Pathol 1998;29:1504)
  • Also called juvenile aponeurotic fibroma
Clinical Features
  • 50% recur, especially in children
  • Does not metastasize
  • May be cartilaginous analog of fibromatosis
Case Reports
  • Conservative excision with reexcision as necessary for recurrences
Clinical Images

Images hosted on other servers:

46 year old woman

36 year old woman with distal phalangeal bone involvement

Gross Description
  • Nodular or infiltrative gray-white, gritty mass in subcutaneous tissue or tendon, may be calcified, usually 3 cm or less in hands or feet, may be larger elsewhere
Micro Description
  • Nodules of plump or epithelioid fibroblasts palisading around cartilage and spotty calcification
  • Cells have indistinct and variable cytoplasm, plump oval nuclei with vesicular chromatin that may be condensed below nuclear membrane
  • Fibrocytes in stroma between nodules have dense, evenly dispersed chromatin
  • May infiltrate fat or striated muscle at periphery
  • Frequent osteoclast-like giant cells
  • Rare mitotic figures, no atypia
  • More cellular in very young
Micro Images

Images hosted on PathOut servers:

Poorly circumscribed
process with scattered,
linear and calcified zones

Amorphous calcification
surrounded by palisading
cells suggestive of rheumatoid
nodule or crystals

Typical zonation pattern
has cellular, plump fibroblastic
cells palisading around a hyalinized
collagenous zone, which in turn
surrounds the calcification

Palm, courtesy of Mark R. Wick, M.D.

Cells adjacent to hyalinized layer are commonly more rounded

Chondroid area is adjacent to calcification

16 year old girl with foot tumor

Images hosted on other servers:


Cytology Description
Negative Stains
Electron Microscopy Description
  • Chondrocytes, fibroblasts and occasional myofibroblasts
Molecular / Cytogenetics Description
Differential Diagnosis
  • Chondroma of soft parts: may involve hands, but usually well circumscribed with more well developed chondroid differentiation, no infiltration of adjacent tissue, no surrounding epithelioid cells
  • Fibrous hamartoma of infancy: immature mesenchyme, fibroblasts are arranged in trabeculae but no palisading, no cartilage or calcification, not hands and feet
  • Infantile fibromatosis: usually involves head, neck and proximal extremities in infants, not hands and feet of children/young adults, background is more myxoid than chondroid, calcification is rare
  • Superficial [palmar and plantar] and desmoid fibromatosis: usually no calcification or chondroid differentiation